Provider Demographics
NPI:1467796748
Name:CLINGINGSMITH, SHANNA R (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:R
Last Name:CLINGINGSMITH
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:4365 E PECOS RD BLDG 14
Mailing Address - Street 2:STE 134
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7875
Mailing Address - Country:US
Mailing Address - Phone:480-840-9155
Mailing Address - Fax:480-840-9320
Practice Address - Street 1:4365 E PECOS RD BLDG 14
Practice Address - Street 2:STE 134
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7875
Practice Address - Country:US
Practice Address - Phone:480-840-9155
Practice Address - Fax:480-840-9320
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2016-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant